Individual
WILMA J MC CLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3799 AFSHARI CIR, FLORISSANT, MO 63034-1527
(314) 879-6300
(314) 879-6372
Mailing address
5535 DELMAR BLVD, SAINT LOUIS, MO 63112-3005
(314) 879-6300
(314) 879-6372
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
070184
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11638556
CAQH
MO
01
—
1962452920
NATIONAL PROVIDER IDENTIFIER
MO
05
—
427400601
—
MO
05
—
815392931
—
MO
Enumeration date
05/11/2006
Last updated
09/19/2011
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